Provider Demographics
NPI:1659528784
Name:BARRY R. GOLDBERG, M.D. LLC
Entity Type:Organization
Organization Name:BARRY R. GOLDBERG, M.D. LLC
Other - Org Name:PERSONALIZED HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:MD/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-433-1709
Mailing Address - Street 1:767 PARK AVENUE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3109
Mailing Address - Country:US
Mailing Address - Phone:847-433-1709
Mailing Address - Fax:
Practice Address - Street 1:767 PARK AVE W
Practice Address - Street 2:SUITE 330
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2400
Practice Address - Country:US
Practice Address - Phone:847-433-1709
Practice Address - Fax:847-681-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty